1141 12-Month Outcomes of Endoscopic Sleeve Gastroplasty: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Endoscopic sleeve gastroplasty (ESG) is a novel moderately-invasive technique in endo-bariatrics, with a theoretical potential to replace laparoscopic sleeve gastrectomy (LSG). We aimed at doing a meta-analysis to study its efficacy and safety. METHODS: We searched multiple databases from inception through March 2019 to identify studies that reported on ESG and LSG in the treatment of obesity. Our goals were to assess the pooled rates of total weight loss (%TWL), excess weight loss (%EWL), and body mass index (BMI) at 1-month, 6-month, and 12-month with ESG. The 12-month outcomes with LSG was used as a comparator group. RESULTS: 7 studies each on ESG (1569 patients) and LSG(2179 patients) were analyzed. Baseline population characteristics were comparable between the groups, except for the mean range of BMI(33.3 to 38.9 in ESG-cohort and 37.4 to 48 in LSG-cohort). The pooled rates of %TWL at 1m, 6m, and 12m were 8.5 (7.7-9.3, I2 = 87.9), 15.4 (13.8-16.9, I2 = 94.7), and 17.5 (14.7-20.3, I2 = 94), respectively. The pooled rates of %EWL at 1m, 6m, and 12m were 30.1 (22.1-38.2, I2 = 96.6), 57.8 (48.6-66.9, I2 = 93.5), and 64.4 (50.3-78.5, I2 = 92.7), respectively. The pooled rates of BMI at 1m, 6m, and 12m were 32.6 (30.4-34.8, I2 = 97.5), 30.9 (29.1-32.6, I2 = 96.7), and 31.3 (27.5-34.9, I2 = 98), respectively. At 12-months, the pooled rates of %TWL, %EWL, and BMI with ESG were 17.5 (14.7-20.3, I2 = 94), 64.4 (50.3-78.5, I2 = 92.7), and 31.3 (27.5-34.9, I2 = 98), respectively; and with LSG were 30.3 (26.6-34.1, I2 = 97), 69.2 (59.7-78.8, I2 = 99), and 29.2 (26.6-31.9, I2 = 98.9), respectively. LSG demonstrated statistically superior %TWL when compared to ESG (P = 0.001), whereas %EWL and BMI at 12-months were comparable (P = 0.57 and 0.38, respectively). The pooled rate of all adverse events with ESG was 3.2% (2-5, I2 = 0) and with LSG was 11.8%(8.4-16.4, I2 = 80), with statistical significance, P = 0.001. The pooled rate of GERD with ESG was 0.5% (0.2-1.7, I2 = 7.3) and with LSG was 5.4%(3.1-9.3, I2 = 73), with statistical-significance, P = 0.001. The mean range of procedure time with ESG was 45 to 80 minutes and with LSG was 60 to 120 minutes. The hospital length of stay with ESG was 1-2 days and with LSG was a mean of 5 to 9 days. CONCLUSION: ESG appears to be an effective alternative option to LSG in the treatment of obesity. ESG has a faster procedure time, shorter hospital length of stay, and better safety profile. Overall, LSG resulted in superior total weight loss compared to ESG at 12-months.